Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Hateful

Hateful patients: It has always been irrational to be forced to treat a patient who is either physically threatening or emotionally abusive. While patients certainly have a right to their emotions, hateful do not have the right to translate them into physical or verbal behavior.

There is a commonly held misperception among the lay public that “healing” someone entails acceptance of some degree of their anger. Patients in extreme pain, patients with poor surgical outcome, and patients demeaned by those involved in their care clearly benefit from being able to verbally resolve those feelings, and they are entitled to support as they deal with these emotions. They are not entitled to punish others for the disappointments that they have suffered.

I had two recent patients, both males, referred for “depression due to pain.” However, very specifically in the referring clinician’s office notes, there is reference to the patient’s hateful behavior as being of abuse of physician and staff. Indeed, there is often as much documentation about the patient’s aversive behavior as there is concerning the patient’s physical findings.

This is not an inappropriate referral: treating the hateful patient takes skill, patience and time, but it also requires that one’s own emotions be set aside as though clinician-emotions are inconsequential, and patient-emotions are the only meaningful agenda. One might assume that being in the patient role is license to abuse those within proximity.

Indeed, this is most true when a psychologist sees a patient. The hostility, anger and resentment expressed are to be treated as symptoms of a broader underlying problem that should be diagnosed and treated. Part of the process includes suffering by the doctor and a freeing up of the patient’s barely contained hatefulness.

Poppycock.

Believe it or not, someone treating a patient is no less a human being than the patient although the doctor is no more human than the patient; merely better informed.

It is more realistic for the patient to understand that this is an environment in which s/he can address the disappointments leading to the hostile feelings. We can proceed if these emotions can be approached in a rational and effective manner. If the patient insists that his/her role includes the right to be punitive and retaliatory, the doctor must set and adhere to limits, even if this means discharging the patient as untreatable in that office